Methods: We used the National Center for Health Statistics Mortality Multiple Cause-of-Death public use data from 2003 to 2014 to identify out-of-hospital (home or dead on arrival), outpatient (Emergency Department or clinic), and inpatient deaths by age, sex, race and ethnicity among children (<19 years) with asthma as the underlying cause of death, using the Marascuilo procedure to compare differences. Rates were calculated using bridged-race population estimates.
Results: There were a total of 2571 pediatric asthma deaths. The average annual mortality rate was six times higher in black as compared to Hispanic and white children (9.29, 1.54, and 1.28 deaths per 1,000,000 persons, respectively). Asthma deaths occurred more frequently in the outpatient setting (51%) compared to the out-of-hospital (14%) and inpatient setting (30%). In the outpatient and out-of-hospital setting, a higher proportion of deaths occurred in black children (59%, 50%) compared to white (24%, 35%) or Hispanic children (12%, 10%, p-value <0.05). Similarly in the inpatient setting, a higher proportion of deaths occurred in black children (50%) compared to white (30%) or Hispanic children (14%, p-value <0.05). Over time, the proportion of outpatient and out-of-hospital deaths have decreased as inpatient deaths have increased.
Conclusions: Variation in the location of pediatric asthma deaths by race/ethnicity may imply differential access to care. Understanding these differences may guide future interventions more effectively.